Diabetic Kidney Disease

 

 

Kidneys’ key function is to filter wastes and excess fluids from the body then dispose of them through the bladder as urine, kidneys also regulate blood pressure and secrete some hormones essential for our health. 

 

What happens if kidneys do not perform their function?

They will fail to purify the blood from wastes, which accumulate in their turn in our bodies, other health issues may also occur.  Diabetes is the primary reason for kidney deterioration 1 in every 4 adults with diabetes suffers from a kidney disease which develops into a more serious condition by time. kidneys’ disease is also known as CKD, diabetic nephropathy, DKD, chronic kidney disease, and kidney disease of diabetes.

 

Factors which may enhance the occurrence of diabetic kidney disease :

Being diagnosed with diabetes for a long period, as extremely high blood pressure and high blood glucose are likely to raise the risk of kidney disease. Other factors include:smoking, heart diseases, consuming food which is high in salt, obesity, non-adherence to the dietary system recommended for people with diabetes, being a member of a family with a history of  kidney failure (kidney failure happens when the kidney’s deterioration aggravates so that it functions with below 15% of its functional capacity, it is also known as end-stage kidney disease (ESRD) and can only be treated by dialysis or kidney transplant, lack of physical exercise

 

How does diabetes lead to kidney disease?

When the glucose level increases in the blood it can damage the blood vessels in the kidney, hence the kidney becomes unable to function properly. Moreover, high blood pressure when combined with diabetes can also affect the kidney’s performance and causes it to malfunction.

 

How does high blood pressure (hypertension) influence the kidney’s functionality?

Hypertension comes second to diabetes as the main cause for kidney disease in the U.S.A. It happens when the force of blood pushing against the blood vessels’ walls increases (normal blood pressure measurement is > 120/80). When this force increases it causes the blood vessels of the kidney to stretch,  over time this stretching weakens and ruins the blood vessels of the entire body and those of the kidneys are no exception. Consequently, when the kidney’s blood vessels start to malfunction they will no longer be able to filter the blood and remove the wastes or excessive fluids, it is important to note here that such excessive fluids can raise the blood pressure more causing a critical condition.

In general, symptoms of high blood pressure do not reveal themselves except for headache in a few cases, so does the kidney disease in its initial phase except for edema (swelling) in the feet, ankles, legs and face and hands in fewer cases. This is considered a  direct result of kidneys malfunction, over time kidneys’ performance starts to become worse and other symptoms start to appear, such as:  

Vomiting, nausea, loss of appetite, abnormal urinary frequency, sleeping disorders, dizziness, exhaustion, weight loss, muscle cramps, change of skin color (darkened skin), skin dehydration, headache, concentration problems, itching/numbness, chest pain and shortness of breath.

 

Diagnosis of diabetic kidney disease:

The majority of diabetic people who also suffer from kidney disease do not show any symptoms, the only way to find out is through carrying out urine tests and blood tests.

  • Urine Tests:
  1. Dipstick test for albumin: One valid way to detect kidneys’ disease is to test for Albumin (the principal protein in the blood that is produced by the liver and can appear in the urine sample when the kidneys are not functioning properly). Patients are required to collect a sample of their urine in a special container to be tested immediately or sent to the laboratory where a strip of chemically treated paper (a dipstick) is dipped into the urine, the change of the dipstick patches color indicates the presence of albumin in the urine sample
  2. Urine albumin-to-creatinine ratio: Creatinine is a waste in the blood that is usually filtered by the kidneys and disposed of through urine. To decide the albumin-to-creatinine ratio, both albumin and creatinine have to be measured, a sign of kidney disease is detected when this ratio is found to be < 30 mg/g.
  • Blood Test: An estimated glomerular filtration rate (eGFR) test may be required to determine the amount of blood that the kidneys filter per minute, test results reveal the following: 
  • eGFR > 60 may refer to a kidney malfunction
  • eGFR 60 is within normal
  • eGFR ≧ 15 may refer to a kidney failure

The National Kidney Foundation encourages people who suffer from hypertension to undergo a number of screenings regularly – as the early detection of kidney malfunction facilitates treatment and decreases the risk of more serious complications. Screenings include:

Testing for urine albumin, eGFR, in addition to the blood pressure tests, these tests should be conducted annually in cases of people with diabetes type 2 or diabetes type 1 who have diagnosed with diabetes for over five years 

Can diabetic kidney disease develop into kidney failure?

Kidney disease caused by diabetes may aggravate with time unless necessary procedures were taken to avoid further deterioration in the kidney condition and impede the occurrence of kidney failure where kidneys functions with no more than 15% of its functional capacity, fortunately not all cases of kidney malfunction develop into kidney failure 

Important tips for diabetic patients on how to maintain their kidneys’ heath 

  • It is indispensable for people with diabetes to maintain both their blood glucose level and their blood pressure level under control in order to avoid the occurrence of diabetic kidney diseases. This could be achieved by adopting a healthy lifestyle and adherence to the directions given to them concerning medication consumption.
  • Patients have to undergo an A1C test regularly – it is a blood test which measures the average blood sugar level within the past three months- high A1C level  indicates a high blood glucose level during the three- month period, optimal percentage of A1C for most people with diabetes should be less than 7%, maintaining blood  glucose level is the main cause for well-functioning kidneys
  • Maintaining blood pressure level within the desired range is very important to protect the patients’ hearts and kidneys against diseases, optimal blood pressure measurement for most diabetic people should be less than 140/90 mm Hg
  • It was found that some medicines which are meant to decrease blood pressure – namely ACE inhibitors and ARBs, also prevent the fast deterioration of kidneys’ condition, yet they are not safe to be used during pregnancy
  • Adopting a healthy lifestyle, because healthy habits help people with diabetes to control their blood glucose level and blood pressure level. Below are some guidelines for people with diabetes to consider in order to preserve the kidneys’ health:
  1. Consult a dietitian when planning a dietary pattern that should be low in salt and sodium
  2. Quit smoking
  3. Exercise regularly 
  4. Sleep well, it is advised to have a good sleep at night that should be no less than  7-8 hours 
  5. Keep fit and maintain a healthy weight
  • Follow medication instructions, as medicines constitute an essential part of treatment, they help in controlling the levels of blood pressure and blood glucose. in some cases, patients are advised to take different types of medicines to keep their blood pressure level within a desirable range
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